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Diffuse alveolar haemorrhage: case report A 69-year-old man experienced diffuse alveolar haemorrhage (DAH) during dual antiplatelet therapy with aspirin and clopidogrel. The man, who had been receiving aspirin and clopidogrel [routes and dosages not stated] for coronary artery disease, presented with cough, dyspnoea and fever for one week. On examination, he was found to have hypoxia and tachypnoea. The man was intubated and mechanically ventilated. X-ray revealed bilateral diffuse opacities. Echocardiography demonstrated good systolic function without any evidence of diastolic dysfunction. Nasal viral PCR returned positive for parainfluenza virus, while respiratory culture was found negative. He was initially treated with IV furosemide without improvement. He subsequently underwent bronchoscopy with bronchoalveolar lavage (BAL). Sequential BAL aliquot sampling revealed progressive haemorrhaging, which confirmed the diagnosis of DAH [duration of treatment to reaction onset not stated]. Microbiologic studies of the BAL fluid were found to be negative for bacteria, acid-fast bacilli, fungi and Pneumocystis jirovecii. Autoimmune and vasculitis work-up were also negative, and his coagulation studies were unremarkable. Therefore, aspirin and clopidogrel were discontinued. Following suspension of aspirin and clopidogrel, his oxygenation gradually improved, and he was eventually weaned off mechanical ventilation. Author comment: "We report a rare case of [diffuse alveolar haemorrhage] caused by parainfluenza virus infection in the setting of dual antiplatelet therapy." "We believe that parainfluenza viral infection in combination with dual antiplatelet therapy led to diffuse alveolar hemorrhage." Khaliq MF, et al. Diffuse alveolar hemorrhage associated with parainfluenza infection and antiplatelet therapy. Critical Care Medicine 47 (Suppl. 1): abstr. 593, No. 1, Jan 2019. Available from: URL: https://journals.lww.com/ccmjournal/ Citation/2019/01001/593__DIFFUSE_ALVEOLAR_HEMORRHAGE_ASSOCIATED_WITH.556.aspx 803432917 [abstract] - USA

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Reactions 9 Nov 2019 No. 1778